Intro

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Last but not least, this blog is going to deal just strictly with the specifics of the Military Disability system that is functioning right now. You might also want to follow our Top News stories for all current news about and future plans for the disability system.

Friday, December 9, 2016

Every few years, Congress
updates the rates given for VA
Disability and Special
Monthly Compensation based on the Cost of Living Adjustments (COLA) that
reflect the rate of inflation throughout the nation.

The last COLA adjustment
was 1.7% in December 2014. This year’s increase, however, is significantly
lower at only 0.3%.

Over the last 10
years, the average COLA adjustment was 1.7% per year. This average has decreased from the previous
decade’s 2.6% per year, and is nowhere near the highest COLA average of 7.3%
per year during the decade from 1975-1984. This shows that the country’s rate
of inflation has significantly slowed over the past 40 years.

Thursday, October 6, 2016

The following are the comments we submitted
on your behalf to the VA in regards to the proposed changes to the ratings of the Skin. After
the VA publishes their proposed changes, they always allow a period for
comments. Thank you for submitting your comments to us so that we could submit
them in a unified front to the VA. Hopefully, we will be able to effect change
and make the rating system more fair for all veterans.

Here are the comments we submitted for Skin
Conditions:

We at www.MilitaryDisabilityMadeEasy.com would like to submit the
following comments on behalf of our staff and veterans in response to the
proposed changes to the ratings of the Skin.

Item #1

The proposed changes for code 7825
urticaria provide ratings for the number of “attacks” which are 6 weeks or more
but doesn’t provide for on-going cases that do not have breaks between attacks.
Although rare, there are documented cases of a single attack lasting years with
no breaks. If the number of attacks is taken literally, then this on-going case
would only count as a single attack and thus only qualify for a 10% rating
although it is far more serious than the cases that qualify for the 60% rating.

We propose that an additional requirement
is added that would allow long-lasting, continuous cases to be rated at the 60%
or above level.

Item #2

For codes 7825 and 7827, in the discussion
of the changes, it says, “The mucosal, palmar, and/or plantar findings would be
restricted to the past 12-month period for all evaluation levels.”

In the ratings, however, it changes the
phrasing from “at least four times during the past 12-month period” to “four or
more times per 12-month period.” This contradicts what is specified in the
discussion.

“Four or more times per 12-month period”
does not indicate at all that it has to be in the past 12 months. If the
past 12 months is required, then changing the phrasing is not justified.

Furthermore, “four or more times per
12-month period” is incredibly vague. Based on the literal statement, if a
veteran has a single year with 4 episodes 20 years ago, then they would qualify,
even though they haven’t had a single episode in years.

If adjusted to “every 12-month period”,
then there is no defining factor as to sufficient history. To qualify, they
would have to have 4 episodes every 12 months for the past 20 years? Is not the
last year enough? Again, this would be vague and leave too much room for faulty
interpretation.

Instead, we suggest leaving the phrasing as
is since “at least four times during the past 12-month period” is very precise
and does not leave things open to interpretation. It also satisfies the intent
of the ratings as noted in the discussion.

Item #3

One of our female veterans brought up a
good point regarding proper ratings for the complete, permanent loss of hair
for females due to service-connected medical conditions.

While she is receiving the maximum rating
possible (20%) under code 7830 for scarring alopecia, baldness in females is
far more socially debilitating than in males, and the ratings do not properly
compensate for the additional needs that females have in order to deal with
this condition.

As she states, “It
seems the alopecia is mostly regarded as a cosmetic issue and is not regarded
for the emotional scarring or financial impact that it has for the veteran that
needs cranial prostheses (wigs) and supplies to maintain the units. Two units
are available to veterans that have lost their hair from chemotherapy because
it is highly suggestive that their hair loss is temporary, unlike veterans like
me whose hair will not return. Therefore, we need access to a lifetime of
cranial prostheses at regular intervals because the units are not built to
last. It has been very costly and difficult to process orders for the cranial
prosthesis because the vendors are few and far between and mostly sell inferior
products for an extreme cost to the government. Therefore, when the government
allots thousands of dollars for one cranial prosthesis (ie $1400-$2400) it is
most difficult for the veteran to get the amount of units needed to sustain
without enduring a financial hardship replacing units while awaiting another
cycle of prostheses that may or may not be received for various reasons.”

It is clear from this
veteran’s experience that she incurs a high financial responsibility that is
not sufficiently covered by a 20% rating or the prosthetic system currently in
place. Whether adjusting the ratings to better cover these costs or adjusting
the prosthetic system, it is an issue that deserves to be recognized and
addressed.

With each set of proposed changes, the VA
allows a period in which comments can be submitted. The VA then takes each
comment into consideration and makes any additional changes that are warranted
before publishing the final ruling.

We encourage you to submit any comments you
might have on these proposed changes to us either by commenting on this post or
by contacting us through our website. All comments must be received by
September 15th, 2016. We will then compile all of your comments into a single
report and submit it on your behalf to the VA, just as we did for the Female Reproductive System. This is a great opportunity to really make a difference,
so please let us know your thoughts.

The following are the VA’s proposed changes
to the ratings for the Skin. The changes are fairly extensive, so I’ll walk
through each, one at a time.

For each condition, the small, indented
parts are the code as it is right now. Click on the code numbers to be taken to
the discussion of that code on our site. After the current code, I’ll discuss
the proposed changes.

First, a few changes to the overall system:

The first proposed change is to add a note
that fully defines systemic vs topical therapies for the treatment of skin
conditions. As it is currently, it is a bit confusing what treatments are
considered which due to the fact that some topical treatments can cause
systemic reactions. Thus, to make it clear, the proposed change defines them as
follows:

- Systemic therapy is any
treatment that is injected, or taken by mouth, through the nose, or anally. This
includes, but is not limited to, corticosteroids, phototherapy, retinoids,
biologics, photochemotherapy, PUVA, and other immunosuppressive drugs.

-
Topical therapy is any treatment applied directly to the skin.

The VA reasons that these specifications
allow for more fair ratings. If topical treatments of a very small skin area
could qualify for a systemic rating, they would get an incredibly high rating
for a fairly insignificant condition. On the other hand, in order for a topical
treatment to cause systemic effects, it would have to be administered regularly
over a very large area of the body. Because of this, a rating for the skin area
alone would give a high enough rating to justify the severity of the condition.

The second proposed change is to create a
Basic Rating System that would be used to rate a number of skin conditions
(though not all). The idea is that these conditions have similar enough
symptoms, treatments, and overall disabilities that a single rating system
would effectively rate each condition. So here is the proposed system:

The Basic Rating System

If the condition covers more than 40% of total
body or more than 40% of exposed divisions affected, or if it requires
the constant or near-constant use of systemic therapy for 12 months, it is
rated 60%.

If the condition covers 20 to 40% of total body
or 20 to 40% of exposed divisions affected, or if it requires the use of
systemic therapy for a total of 6 weeks or more every 12 months, it is rated
30%.

If the condition covers 5 to 20% of total body
or 5 to 20% of exposed divisions affected, or if it requires the use of
systemic therapy for a total of less than 6 weeks every 12 months, it is rated
10%.

If the condition covers less than 5% of total
body or less than 5% of exposed divisions affected, or if it requires only
topical medications every 12 months, it is rated 0%.

Note:
The VA proposes changing the terminology of the VASRD from “during the past
12-month period” to “per 12-month period.” They say this change adds clarity,
but in reality, it doesn’t. With this change, it isn’t clear whether or not
that means the past 12 months, or any 12-month period during the past 20 years.
For the purposes of this blog, I’ve interpreted it as “every 12 months”, but
acknowledge that this probably isn’t really what they meant either since their
discussions often still say “past 12 months.” This is a definite issue that
they need to clearly clarify before publishing the final changes, and one that
I will be addressing in the comments we submit. Just note that anytime in this
blog that I say “every 12 months”, the real meaning is still to be determined.
I think the most logical interpretation is still the “past 12 months,” but
since they made a big to-do about changing it, I couldn’t just leave it as is.

I’m going to discuss the changes for codes 7801,
7802, and 7805 together. These codes are fairly extensive, so I’m not going to
reproduce the current ones here. Click on the linked codes just listed to go
the discussion of them on our site. Here are the proposed codes:

-Proposed-Scars
of the Body

Scars of the body are any scars that are not found on the head, face, and
neck.

Important! Each part of the body that is
affected by a scar can be rated separately! Woo-hoo! For each kind of scar
(deep, code 7801, superficial, code 7802, or other, code 7805), a single rating
is given for each area of the body affected. These ratings are then combined
using VA Math into a single overall scar rating assigned under the
corresponding code. So if there are multiple scars or a single scar that affects
more than one part of the body, then each is rated separately and then combined
into a single overall rating for that kind of scar. For example, if a deep scar
on the back is rated 30% and a deep scar on the stomach is rated 20%, the
ratings would be combined using VA Math into a single 40% overall rating for deep
scars.

If, however, a higher rating can be achieved by adding the measurements
for all of the scars in all the areas of the body together, then this rating
can be given instead. For example, if there is a single deep scar that measures
6 in2 but is divided between two areas (each 3 in2), then
only a 0% would be given. But if the two areas are combined into 6 in2,
then it would qualify for a 10% rating.

Below is a picture of the different areas of the body
that can be rated separately. There are 6 areas in total, and they include the
right arm, the left arm, the right leg, the left leg, the front of the torso,
and the back of the torso. The front and back of the torso are separated by the
midline on the side of the body. (The neck and head are rated under code 7800).

Time for the ratings:

Code 7801:Deep scars are considered “deep” if there is damage to the soft
tissues under the skin. If the area of scarring in a single body part is 144 in2
or bigger, then it is rated 40%. If the area is between 72 in2
and 144 in2, it is rated 30%. If the area is between 12 in2
and 72 in2, then it is rated 20%. If it is between 6 in2
and 12 in2, it is rated 10%.

Code 7802:Superficial scars are ones that only affect the skin, not the soft
tissues underneath. If the area of scarring in a single body part is 144 in2
or more, it is rated 10%. No other rating is given for superficial scars under
this code.

Code 7805:
All other scars are not ratable in
and of themselves. If they cause another condition that makes it hard to
properly do your job, then that other condition is rated. So, for example, if a
linear scar running up the arm makes it impossible to fully bend or straighten
the arm at the elbow, then it is rated under limited motion of the elbow. The
final code will look like this: 7805-3400. The first four-digit code defines
the condition as a linear scar, and the second four-digit code tells how it is
rated.

The biggest change for these codes is
getting rid of the differentiation between linear and non-linear scars. Under
the current codes, linear scars are pretty much not ratable, even if they are
considered deep. The proposed changes, however, allow for linear scars to be
rated the same as non-linear scars. So a deep linear scar that measures at
least 6 in2 would qualify for a 10% rating instead of receiving nothing.

The only other change is to allow all the
areas of the body to be combined and then rated (instead of rated separately
and then combined) if it would provide a higher rating.

-Current- Code 7806: Dermatitis and eczema are essentially
the same thing, although some doctors might describe them slightly different.
For rating purposes, however, they are treated the same. Basically, dermatitis
is a condition where the skin swells and turns red—the standard rash.

There are three different
rating options for this condition. If the condition is so severe that it causes
permanent scars, it can be rated as a scar condition under a scar code. The
final code in that case would look like this: 7806-7801. The first four-digit
code defines the condition as dermatitis, and the second four-digit code tells
how it is rated.

It can also be rated under
this code either on calculations/estimations or on the required treatment of
the condition itself.

Calculations/estimations: If
there is more than 40% of total body or more than 40% of exposed divisions
affected, it is rated 60%. If there is 20 to 40% of total body or 20 to 40% of
exposed divisions affected, it is rated 30%. If there is 5 to 20% of total body
or 5 to 20% of exposed divisions affected, it is rated 10%. If there is less
than 5% of total body or less than 5% of exposed divisions affected, it is
rated 0%.

Treatments: If the condition
required the almost constant use of oral or injected medications to regulate
the immune system over the past 12 months (methotrexate, steroids, etc.), it is
rated 60%. If the condition required oral or injected medications to regulate
the immune system for a total of 6 weeks or more during the past 12 months, it
is rated 30%. If the condition required oral or injected medications to
regulate the immune system for a total of less than 6 weeks over the past 12
months, it is rated 10%. If the condition only required topical (put on the
outside of the skin) medications over the past 12 months, it is rated 0%.

-Proposed-Code 7806:Dermatitis and eczema
are essentially the same thing, although some doctors might describe them
slightly different. For rating purposes, however, they are treated the same.
Basically, dermatitis is a condition where the skin swells and turns red—the
standard rash.

This
condition is rated on the Basic Rating System. If, however, the condition is so
severe that it causes permanent scars, it can be rated as a scar condition
under a scar code. The final code in that case would look like this: 7806-7801.
The first four-digit code defines the condition as dermatitis, and the second
four-digit code tells how it is rated.

In reality, the proposed changes don’t
change the ratings themselves for this code. The new Basic Rating System gives
the same ratings it currently has.

-Current- Code 7809: Lupus is a condition where the immune
system attacks the healthy cells of the skin, causing severe sores, tearing,
and scarring of the skin. Most often, these occur on the head near the ears,
eyes, nose, lips and cheeks, but in some cases lupus sores can affect other
areas of the body. Lupus is either rated as dermatitis or as scars/disfigurement,
whichever best describes the disability. The final code will look like this:
7809-7801. The first four-digit code defines the condition as lupus, and the
second four-digit code tells how it is rated.

If the lupus affects parts of
the body besides the skin, then it is rated under code 6350 for systematic
lupus erythematosus. A rating cannot be given under both codes. Only one or the
other.

-Proposed-Code 7809:Lupus
is a condition where the immune system attacks the healthy cells of the skin,
causing severe sores, tearing, and scarring of the skin. Most often, these
occur on the head near the ears, eyes, nose, lips and cheeks, but in some cases
lupus sores can affect other areas of the body.

This
condition is rated on the Basic Rating System. If, however, the condition is so
severe that it causes permanent scars, it can be rated as a scar condition
under a scar code. The final code in that case would look like this: 7809-7801.
The first four-digit code defines the condition as lupus, and the second
four-digit code tells how it is rated.

If the
lupus affects parts of the body besides the skin, then it is rated under code 6350
for systematic lupus erythematosus. A rating cannot be given under both codes.
Only one or the other.

Again, the ratings for this code don’t
change at all since the Basic Rating System is the dermatitis rating system and
the scar option still applies.

The main change is to move the rating of
subacute cutaneous lupus erythematosus to code 7821. Right now, it is rated
here, but based on more thorough and modern medical knowledge, the VA wants to
move the rating of subacute cutaneous lupus erythematosus to code 7821 because
the condition is actually closer to collagen-vascular disease than this lupus.

-Current- Code 7813: Dermatophytosis (“ringworm”) is a fungal infection that causes ring-shaped red and
swollen patches on the skin. This condition is either rated under dermatitis,
or scars/disfigurement whichever best describes the disability. The final code
will look like this: 7813-7801. The first four-digit code defines the condition
as dermatophytosis, and the second four-digit code tells how it is rated.

-Proposed-Code 7813:Dermatophytosis
(“ringworm”) is a fungal infection
that causes ring-shaped red and swollen patches on the skin.

This
condition is either rated under the Basic Rating System, or scars/disfigurement
whichever best describes the disability. If rated on scars/disfigurement, the
final code will look like this: 7813-7801. The first four-digit code defines
the condition as dermatophytosis, and the second four-digit code tells how it
is rated.

Again, the ratings for this code don’t
change at all since the Basic Rating System is the dermatitis rating system and
the scar option still applies.

The VA does specify a few additional
conditions that are rated under this code, namely onychomycosis and tinea
versicolor, but these are forms of dermatophytosis and so are rated here
already anyway. All of the various kinds of dermatophytosis are rated here.

-Proposed- Code 7815:Bullous disorders
cause blisters of clear liquid to form in between the layers of the skin, most
often on the inner thighs and upper arms.

This
condition is either rated under the Basic Rating System, or scars/disfigurement
whichever best describes the disability. If rated on scars/disfigurement, the
final code will look like this: 7815-7801. The first four-digit code defines
the condition as a bullous disorder, and the second four-digit code tells how
it is rated.

If the
condition causes symptoms that affect other parts of the body besides the skin,
it can be rated separately. So if it affects the lungs, it can receive a second
rating under the lung code that best describes the symptoms.

This code has only a minor change, so I
didn’t reproduce the original here. The only significant change to this code is
the ability to rate additional symptoms under separate codes. Currently, no
ratings are given if the condition affects other areas of the body.

-Proposed-Code 7816:Psoriasis is an autoimmune condition
that tells the body to produce more skin cells even though they are not needed.
This can cause numerous different things to happen to the skin, including
redness, swelling, scaly texture, patches of red bumps, and more.

This condition
is either rated under the Basic Rating System, or scars/disfigurement whichever
best describes the disability. If rated on scars/disfigurement, the final code
will look like this: 7816-7801. The first four-digit code defines the condition
as psoriasis, and the second four-digit code tells how it is rated.

If the
condition causes symptoms that affect other parts of the body besides the skin,
it can be rated separately. So if it causes psoriatic arthritis, it can receive
a second rating under code 5002 for rheumatoid arthritis, etc.

Like the last code, this code has only a
minor change, so I didn’t reproduce the original here. The only significant
change to this code is the ability to rate additional symptoms under separate
codes. Currently, no ratings are given if the condition affects other areas of
the body.

-Current- Code 7817: Exfoliative dermatitis (erythroderma) is a dermatitis that
causes a scaly rash that covers the majority of the entire body. It is normally
caused by another condition, like cancer or a reaction to a medication. If that
condition is unfitting by itself, then the exfoliative dermatitis can only be
rated as well if it contributes significantly to making the service member
unfitting (super sensitive to motion, can’t wear his uniform, etc.).

If the majority of the skin
is affected and things such as weight loss, fever, low protein in the
blood, etc., are present, and continuous medications to regulate the
immune system (methotrexate, steroids, etc.) were taken over the past 12 months
or regular treatments of ultraviolet or other light wave/beam therapy were
needed during the past 12 months, it is rated 100%.

If the majority of the skin
is affected, and continuous medications to regulate the immune system
were taken over the past 12 months or regular treatments of ultraviolet
or other light wave/beam therapy was needed during the past 12 months, it is
rated 60%.

Regardless of how much skin
is affected, if medications to regulate the immune system or ultraviolet
or other light wave/beam therapy were needed for a total of 6 weeks (does not
need to be consecutive) or more during the past 12 months, it is rated 30%.

Regardless of how much skin
is affected, if medications to regulate the immune system or ultraviolet
or other light wave/beam therapy were needed for a total of less than 6 weeks
(does not need to be consecutive) or more during the past 12 months, it is
rated 10%.

Regardless of how much skin
is affected, if only topical treatments were used during the past 12 months, it
is rated 0%.

-Proposed-Code 7817:Erythroderma is a dermatitis that
causes a scaly rash that covers the majority of the entire body. It is normally
caused by another condition, like cancer or a reaction to a medication. If that
condition is unfitting by itself, then the exfoliative dermatitis can only be
rated as well if it contributes significantly to making the service member
unfitting (super sensitive to motion, can’t wear his uniform, etc.).

If the
majority of the skin is affected and things such as weight loss, fever,
low protein in the blood, etc., are present, and either 1.) continuous systemic
treatments (corticosteroids, immunosuppressive retinoids, biologics, etc.) were
taken over the past 12 months or 2.) regular treatments of ultraviolet
or other light wave/electron beam therapy were needed during the past 12
months, it is rated 100%. A 100% rating is also given if no treatment is
currently being attempted since at least 2 treatment regimens failed in the
past. The failed regimens must be clearly documented.

In order
to have “failed” the condition must have either gotten worse after the regimen
or had less than 25% reduction in the severity after 4 weeks of treatment.

If the
majority of the skin is affected, and either 1.) continuous systemic
treatments were taken over the past 12 months or 2.) regular treatments
of ultraviolet or other light wave/electron beam therapy was needed during the
past 12 months, it is rated 60%. A 60% rating is also given if no treatment is
currently being attempted since 1 treatment regimen failed in the past. The
failed regimen must be clearly documented.

Regardless
of how much skin is affected, if systemic treatments or ultraviolet or
other light wave/electron beam therapy were needed for a total of 6 weeks (does
not need to be consecutive) or more during the past 12 months, it is rated 30%.

Regardless
of how much skin is affected, if systemic treatments or ultraviolet or
other light wave/electron beam therapy were needed for a total of less than 6
weeks (does not need to be consecutive) or more during the past 12 months, it
is rated 10%.

Regardless
of how much skin is affected, if only topical treatments were used during the
past 12 months, it is rated 0%.

The first change to this code is to get rid
of “exfoliative dermatitis” from the title since it is a dated term that is no
longer really used for this condition. The VA also more clearly specified and
included new systemic treatment options in the rating criteria. Finally, the VA
added a rating option to compensate those veterans who are not undergoing
treatment because previous treatments had failed. In the majority of these
cases, the treatment failure is caused by the severity of the underlying
condition and treatment failure of that condition. These cases currently cannot
be rated although their condition is significant.

-Current- Code 7820: All other infections of the skin that
are not listed elsewhere are rated under this code. These conditions are either
rated as dermatitis or as scars/disfigurement, whichever best describes the
disability. The final code will look like this: 7820-7801. The first four-digit
code defines the condition as a skin infection, and the second four-digit code
tells how it is rated.

-Proposed-Code 7820:All
other infections of the skin that are not listed elsewhere are rated under
this code.

These
conditions are either rated under the Basic Rating System, or as scars/disfigurement,
whichever best describes the disability. If rated on scars/disfigurement, the
final code will look like this: 7820-7801. The first four-digit code defines
the condition as a skin infection, and the second four-digit code tells how it
is rated.

The only change to this code
is to include the Basic Rating System. No real effect on the ratings
themselves.

-Current- Code 7821: Cutaneous manifestations of
collagen-vascular diseases are skin conditions that occur when the immune
system attacks the collagen. Collagen is the proteins that are in the skin.
Psoriasis is considered a collagen-vascular disease. This code is used to rate
any collagen-vascular disease that is not listed elsewhere on this page.

-Proposed-Code 7821:Cutaneous
manifestations of collagen-vascular diseases are skin conditions that occur
when the immune system attacks the collagen. Collagen is the proteins that are
in the skin. Psoriasis is considered a collagen-vascular disease. This code is
used to rate any collagen-vascular disease that is not listed elsewhere on this
page, including subacute cutaneous lupus erythematosus.

This
condition is rated on the Basic Rating System. If, however, the condition is so
severe that it causes permanent scars, it can be rated as a scar condition
under a scar code. The final code in that case would look like this: 7821-7801.
The first four-digit code defines the condition as a collagen-vascular disease,
and the second four-digit code tells how it is rated.

The main change for this code
is to include subacute cutaneous lupus erythematosus instead of it being rated
under code 7809. The ratings themselves, although reformatted as the Basic
Rating System, do not change.

-Proposed-Code 7822:
Any other skin conditions that cause
hard, scaly bumps (“papulosquamous
disorders”) to form on the skin that are not listed anywhere else on this
page are rated under this code, including mycosis fungoides, lichen planus,
plaque parapsoriasi, PLEVA, PRP, lymphomatoid papulosus, and more.

This
condition is either rated under the Basic Rating System, or scars/disfigurement
whichever best describes the disability. If rated on scars/disfigurement, the
final code will look like this: 7822-7801. The first four-digit code defines
the condition as a papulosquamous disorder, and the second four-digit code
tells how it is rated.

Besides adjusting things for the Basic Rating
System, the primary change to this code is to further clarify some of the
specific conditions rated under this code, specifically mycosis fungoides which
is often misrated under other codes.

-Current- Code 7824: Diseases of keratinization affect the
process where the lower layers of the skin turn into the harder outer layer of
skin. Keratin is the protein that causes the skin to harden. Any condition that
affects the process of keratinization is rated under this code.

If the condition affects the
whole body and required almost constant oral or injected medication over the
past 12 months, it is rated 60%. If the condition affects the whole body and
required the use of oral or injected medication for a total of at least 6 weeks
during the past 12 months, it is rated 30%. If the condition only affects some
areas of the body and required the use of oral or injected medication for a
total of less than 6 weeks during the past 12 months, it is rated 10%. If only
topical treatments were required during the past 12 months, it is rated 0%.

-Proposed-Code
7824:Diseases of keratinization
affect the process where the lower layers of the skin turn into the harder
outer layer of skin. Keratin is the protein that causes the skin to harden. Any
condition that affects the process of keratinization is rated under this
code. This condition is rated under
the Basic Rating System.

The only change to this code is to have it
solely rated under the Basic Rating System.

-Current- Code 7825: Chronic hives are pale red, itchy bumps
on the skin that are caused either by allergic reactions or various other
causes. To qualify as chronic, they must last for 6 weeks or more. If there
were severe debilitating (it’s impossible to do your job) episodes that
occurred at least 4 times over the past 12 months that cannot be controlled by
treatment, it is rated 60%. If there were severe debilitating episodes that
occurred at least 4 times over the past 12 months but it could be controlled by
medications that regulate the immune system (methotrexate, steroids, etc.) it
is rated 30%. If there were episodes (not debilitating) that occurred at least
4 times over the past 12 months, but the condition could be controlled by
medications that control swelling, it is rated 10%.

-Proposed-Code 7825:Chronic hives are pale red, itchy bumps
on the skin that are caused either by allergic reactions or various other causes.
To qualify as chronic, they must last for 6 weeks or more and recur
occasionally. An “attack” is a single period of chronic hives that lasts at
least 6 weeks. All attacks must be officially medically documented to count
towards a rating.

If there
are 4 or more attacks every 12 months that cannot be controlled by treatment,
it is rated 60%.

If there
are 4 or more attacks every 12 months that can be controlled by medications
that supress the immune system (steroids, cyclosporine, etc.), it is rated 30%.

If there
are 1 to 3 attacks every 12 months that can be controlled by medications that supress
the immune system, it is rated 10%.

A 10%
rating is also given if there are 4 or more attacks every 12 months that are
treated by antihistamines or sympathomimetics, or if there are no
documented attacks because it is sufficiently controlled by continuously taking
medications that supress the immune system.

The VA proposes a number of
changes to the ratings for hives. Currently, the ratings are based on
debilitating episodes. To make the requirements more clear, the VA proposes
using “attacks” instead of “debilitating episodes.” Basically, as long as a
period of hives of 6 weeks or more is officially documented, it counts as an
attack. It does not have to be specifically noted as debilitating.

More significantly, the VA
adds two additional rating criteria for the 10% rating in order to more
completely cover the level of disability presented by conditions that are only
treated with “less severe” medications or that are controlled successfully by
constant medication. This broadens the number of cases that will be able to
qualify for a rating under this code.

-Current-Code 7826:
Primary cutaneous vasculitis is a
condition of the small blood vessels near the skin, which causes them to burst.
The skin turns red or purple due to bleeding under the skin. If this condition
is caused by other conditions, like infections, medications, cancer, autoimmune
disorders, etc., it can only be rated as that condition. If it is not caused by
another condition, then it can be rated here. Likewise, if the condition caused
significant scarring, it can be rated under the scar codes. Choose the one
rating system that would give the highest rating.

If
there were at least 4 debilitating (can’t perform your job) episodes over the
past 12 months that did not respond to treatment, it is rated 60%. If there
were at least 4 debilitating episodes over the past 12 months that were controlled
by medications that regulate the immune system (methotrexate, steroids, etc.),
then it is rated 30%. If there were 1 to 3 episodes (not debilitating) over the
past 12 months that were controlled by medications that regulate the immune
system, then it is rated 10%.

-Proposed-Code
7826:Primary
cutaneous vasculitis is a condition of the small blood vessels near the
skin, which causes them to burst. The skin turns red or purple due to bleeding
under the skin. If this condition is caused by other conditions, like
infections, medications, cancer, autoimmune disorders, etc., it can only be
rated as that condition. If it is not caused by another condition, then it can
be rated here. Likewise, if the condition caused significant scarring, it can
be rated under the scar codes. Choose the one rating system that would give the
highest rating.

An
“episode” is a period of active symptoms. All episodes must be medically
documented to count towards a rating.

If there
are regular and consistent episodes where the symptoms do not properly respond
to continuous medications that supress the immune system, it is rated 60%.

If there
are 4 or more episodes every 12 months that can be controlled by medications
that suppress the immune system (steroids, cyclosporine, etc.), it is rated
30%.

If there
are 1 to 3 episodes every 12 months that can be controlled by medications that
suppress the immune system, it is rated 10%.

A 10%
rating is also given if there are no documented episodes because it is
sufficiently controlled by continuously taking medications that suppress the
immune system.

Similar to the changes for
hives, the VA proposes to get rid of “debilitating episodes” and replace it
with “episodes.” It does not have to be specifically noted as debilitating. The
VA also adds one additional rating criteria for the 10% rating in order to more
completely cover the level of disability presented by conditions that are
controlled successfully by constant medication. This broadens the number of
cases that will be able to qualify for a rating under this code.

-Current- Code 7827: Erythema multiforme (toxic epidermal necrolysis, “TENs”) is
either caused by an infection or is a reaction to medication. It causes red
skin rashes and bumps to appear all over the body. It then attacks and kills
the skin all over the body, causing the top layer of skin to detach from the
lower layers all over the body, which can send the organs into failure. If the
condition caused significant scarring, it can either be rated under the scar
codes or this code. Choose the one that would give the highest rating.

If there were severe
debilitating (it’s impossible to do your job) episodes that occurred at least 4
times over the past 12 months that could not be controlled by treatment, it is
rated 60%. If there were episodes (not debilitating) that occurred at least 4
times over the past 12 months but it could be controlled by medications that
regulate the immune system, it is rated 30%. If there were episodes (not
debilitating) that occurred 2 or 3 times over the past 12 months that were
controlled by medications that control swelling, it is rated 10%. A 10% rating
is also given if there were 1 to 3 episodes that occurred over the past 12
months that were controlled by medications that regulate the immune system.

-Proposed-Code 7827:Erythema
multiforme and toxic epidermal
necrolysis (“TENs”) are both rated under this code. Both are either caused
by an infection or are reactions to medication. They cause red skin rashes and
bumps to appear all over the body. They then attack and kill the skin all over
the body, causing the top layer of skin to detach from the lower layers, which
can send the organs into failure. Erythema multiforme is less severe than TENs,
usually only affecting less than 10% of the body. If the condition causes significant scarring,
it can either be rated under the scar codes or this code, whichever gives the
highest rating.

While both conditions can cause symptoms
anywhere on the body, notable disabilities are caused when they affect the
mouth (difficulty chewing), the hands (difficult gripping), or the feet
(difficulty walking).

If the condition causes 4 or more episodes of
mouth, hand, or foot impairment every 12 months despite constant medications that
suppress the immune system, it is rated 60%.

If it causes 4 or more episodes of mouth, hand,
or foot involvement (but doesn’t impair their functions) every 12 months that
require occasional systemic treatments (immunosuppressives, antihistamines, or
sympathomimetics), it is rated 30%.

If it causes 1 to 3 episodes of mouth, hand, or
foot involvement (but doesn’t impair their functions) every 12 months that
require occasional systemic treatments, it is rated 10%.

A 10% rating is also given if there are no
episodes, but it requires continuous systemic treatments to control the
symptoms.

The VA notes that for these
conditions to be “debilitating” there must be mouth, hand, or foot involvement.
So instead of using the vague phrase, they instead propose to change the rating
requirements to specify mouth, hand, or foot involvement and the severity of
that involvement.

-Current- Code 7828: Acne is a skin
condition that causes puss-filled raised bumps that can occur anywhere on the
body.

Code 7829: Chloracne is a
condition where acne erupts over patches of skin that have come in contact with
chemicals that contain dioxins.

Some acne is very
superficial, involving only one layer of the skin, while other acne can be very
deep. Often acne causes scarring. If the scars are the main disability, then
this condition can be rated under the scar codes.

The ratings: If the acne is
deep, causing inflammation and puss-filled cysts, and affects 40% or more of
the face and neck, it is rated 30%. If the acne is deep, causing inflammation
and pussy cysts, and affects less than 40% of the face and neck, or if
deep acne is in areas other than the face and neck, it is rated 10%. If the
acne is superficial, it is rated 0%.

-Proposed-Code 7828:Acne
is a skin condition that causes puss-filled raised bumps that can occur
anywhere on the body.

Some acne is very superficial, involving only
one layer of the skin, while other acne can be very deep. Often acne causes
scarring. If the scars are the main disability, then this condition can be
rated under the scar codes.

If the acne is deep, causing inflammation and
puss-filled cysts, and affects 40% or more of the face and neck, it is rated
30%. If the acne is deep, causing inflammation and puss-filled cysts, and
affects less than 40% of the face and neck, or if deep acne is in areas
other than the face and neck, it is rated 10%. If the acne is superficial, it
is rated 0%.

Code
7829:Chloracne is a condition where acne
erupts over patches of skin that have come in contact with chemicals that
contain dioxins.

Some chloracne is very superficial, involving
only one layer of the skin, while other chloracne can be very deep. Often
chloracne causes scarring. If the scars are the main disability, then this
condition can be rated under the scar codes.

If the chloracne is deep, causing inflammation
and puss-filled cysts, and affects 40% or more of the face and neck, it is
rated 30%.

A 20% rating is given if the chloracne is deep,
causing inflammation and puss-filled cysts, and affects at least one of the
following areas: the armpit, the genital region, the folds of the breast, and
the areas between the fingers and toes.

If the chloracne is deep, causing inflammation
and puss-filled cysts, and affects less than 40% of the face and neck, or
if deep chloracne is in areas other than the face and neck or the areas noted
above, it is rated 10%.

If the chloracne is superficial, it is rated
0%.

The only proposed change to code 7828 for acne
is to remove the term that is no longer used. In reality, nothing changes at
all.

For code 7829 for chloracne, however, the VA
adds a new 20% rating for deep acne that is found in certain regions on the
body. Deep, painful acne in these regions would cause a higher level of
disability because of the difficulty of movement it would cause, so the VA
feels that a 20% rating would more fully reflect the level of disability.